乳腺癌治疗后妊娠的可行性及安全性

Feasibility and safety of pregnancy after treatment of breast cancer

目的随着乳腺癌逐渐年轻化及国家二胎政策的放开,乳腺癌患者对生育要求增加。本研究旨在探讨乳腺癌治疗后妊娠对患者预后的影响。方法应用检索维普、万方、CNKI、Medline期刊全文数据库的检索系统,以"乳腺癌、综合治疗、妊娠、预后"等为关键词,检索1957-01-2016-06的相关文献,共检索到英文文献307条,中文文献106条。纳入标准:(1)有关乳腺癌治疗后妊娠;(2)有关生育方面问题。剔除标准:(1)妊娠期乳腺癌;(2)非乳腺癌治疗后妊娠。根据纳入排除标准,符合分析的文献24篇。结果目前的研究结果显示,乳腺癌治疗后妊娠对预后无不良影响。乳腺癌综合治疗,尤其是化疗,可能会影响患者生育能力,患者治疗前可以考虑卵巢保护措施,化疗中选择对卵巢损害小的药物,以保障治疗后妊娠相对较高的成功率。乳腺癌患者治疗后妊娠不增加其后代畸形或者智力低下的风险。对于早期的乳腺癌患者,建议结束治疗后两年妊娠;Ⅲ期乳腺癌患者建议五年后妊娠。结论本研究在现有的循证医学证据下发现,在充分的卵巢保护,合理的选择化疗用药,并在乳腺癌综合治疗结束后间隔足够时间的前提下选择妊娠,对乳腺癌患者的预后无不利影响。

OBJECTIVE As more young women are diagnosised breast cancer, and the two-child policy has been opened by Chinese government, the number of breast cancer patients who demand childbearing is increasing. The purpose of this study was to investigate the effect of pregnancy on the prognosis of patients with breast cancer after treatment. METItODS With -breast cancer; treatment; pregnancy; prognosis- as key words, the literature were searched in Wan- fang Data, VIP database, CNKI and Medline database searching system between 1957-01 and 2016-06. The number of English literature is 307 and Chinese literature is 106. The inclusion criteria： （1） pregnancy after treatment of breast cancer; （2） the studies on reproduction. Exclusion criteria： （1） breast cancer during pregnancy; （2） non pregnancy after treatment of breast cancer. 24 articles were enrolled in this paper according to the criteria. RESULTS In existent re- searching, pregnancy after treatment of breast cancer has no adverse effect on prognosis. Comprehensive treatment of breast cancer, especially chemotherapy, may destroy patient＇s fertility. To increase conception rate after tumor treatment, patients can preserve their ovarian function before tumor treatment, and choose lower ovarian toxicity drugs during tumor treatment. Subsequent pregnancy has not shown an increased risk of fetal malformation or mental retardation. When the tumor treatment is completed, it is suggested to wait for at least two years before pregnancy for patients with early stage breast cancer, and at least five years for phase III breast cancer. CONCLUSIONS In the set of ovarian protection, selec- ting the adaptive drugs for chemotherapy and sufficient time after comprehensive treatment, the available evidence-based practices consider that the pregnancy after breast cancer treatment has no adverse affects on the prognosis of breast cancer patients.